Seed implantation is finally officially recognized

Joint Federal Committee attests LDR brachytherapy great benefit and fewer side effects compared to surgery.

Better late than never: While national and international medical societies have firmly established seed implantation in their guidelines for around 20 years, the Federal Joint Committee (G-BA) is now following suit and giving the green light for the modern, radiation therapy procedure. In its decision of September 17, 2020, the committee attests that low-dose rate (LDR) brachytherapy (seed implantation) is of great benefit in the treatment of tumors that are restricted to the prostate (localized prostate cancer). The G-BA also sees advantages in terms of the fewer side effects of the method. In the future, therefore, not only clinics but also general practitioners specializing in urology and radiotherapy will be allowed to treat patients with low-risk prostate cancer with seed implantation.

"For years, we have been campaigning for the recognition of brachytherapy in Germany. Now, finally, men with a localized prostate carcinoma can be treated in this country in a targeted and gentle manner that meets international standards", says Dr. Stephan Neubauer from the West German Prostate Center. As a pioneer of brachytherapy in Germany, the interdisciplinary center in Cologne has performed more than 8,000 treatments with organ-preserving, minimally invasive radiation since 2000. The center now has 20 years of follow-up data at its disposal, which are stored in a database and continuously evaluated in scientific studies.

Fewer side effects due to precise irradiation

Instead of removing the entire prostate in an operation that is often stressful for the patient, seed implantation involves targeted radiation of the tumor from within. For this purpose, tiny radiation sources are brought directly into the prostate. The radiation dose is calculated precisely by computer technology, so that the prostate is irradiated with pinpoint accuracy without damaging surrounding structures such as the bladder, bowel or sphincter. "This has the advantage that the men can continue to hold their urine and do not have to rely on templates. Problems with potency and libido also occur significantly less frequently than after the operation," says Dr. Neubauer.

Scientific studies on seed implantation convince G-BA

The G-BA also emphasizes the advantages of seed implantation with regard to side effects and quality of life: "Compared to the other available therapy alternatives, such as removal of the prostate or external radiation therapy, brachytherapy has a different, often more beneficial side effect profile for the patient. Especially for patients, who reject a removal of the prostate as too stressful and for whom even an external radiation therapy of several weeks is out of the question, the LDR brachytherapy can be the appropriate therapy option", the resolution states.

The panel bases its assessment on the scientific data available on seed implantation for localized prostate cancer. In addition to the results of the Institute for Quality and Efficiency in Health Care (IQWiG), further evidence in the form of health technology assessment reports, current systematic reviews and guidelines, in particular the German S-3 guideline, as well as assessments and statements of leading urologists and professional societies were considered.

In the future, physicians will also be obliged to provide information on seed implantation

While in many places the diagnosis of prostate cancer automatically leads to surgical removal of the prostate - often with serious side effects such as loss of potency and problems in holding urine - according to the G-BA decision, doctors will in future be obliged to provide their patients with patient information explaining the advantages and disadvantages of all established treatment options. The aim is to "support the personal weighing process".

"Even if the decision should have been made much earlier, it will finally give the affected patients with prostate cancer the opportunity to choose the optimal treatment strategy for themselves," summarizes Dr. Neubauer.

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